New hope for diabetes patients with kidney failure

Rigshospitalet is the first Danish hospital in 21 years to perform a combined kidney and pancreas transplant on a diabetes patient with kidney failure. 
​A surgical team at Rigshospitalet has performed the first pancreas transplant in Denmark in 21 years. The operation was performed on 7 August, and at the same time the patient underwent a kidney transplant. The patient has now been discharged from hospital and is doing well. 

According to Jannik Hilsted, Chief Medical Officer at Rigshospitalet, this is a breakthrough in Denmark.

- We're very pleased that once again we're finally able to perform pancreas transplants in Denmark. New surgical methods and new medicines have created better conditions for this type of surgery, and this gives new hope to a group of very ill patients," said Jannik Hilsted.

Kidney failure is a frequent complication for diabetes patients. About 25% of the patients in Denmark who need dialysis due to chronic loss of their kidney function suffer from diabetes. 

- For some patients with type 1 diabetes, simultaneous transplant of pancreas and kidney can be a good treatment, and it can normalise patients' blood sugar, thus eliminating the need for insulin injections. These patients can avoid serious cases of hypoglycaemia, improve their quality of life and hopefully also life expectancy, said Professor Søren Schwartz Sørensen from Rigshospitalet.

After a successful transplant, patients will be able to do without insulin. In return, they must take life-long medicine that prevents their body from rejecting the transplanted organs. For this reason Rigshospitalet only performs pancreas transplants on patients who also have to undergo a kidney transplant and therefore will have to take this medicine anyway. 

The Danish Patient Association is excited
- We're very pleased that Rigshospitalet is making an effort to help this group of very ill patients who now have a second chance with the transplant. Although a transplant is not the solution for the majority of diabetics with kidney failure, the important aspect here is that the possibility now exists. This gives hope to a group of very ill patients, said Henrik Nedergaard, CEO at the Danish Diabetes Association.
 
Kidney disease is a very serious diabetes complication. About one-third of all diabetics, irrespective of type, experience problems with their kidneys. Ultimately these problems can develop into chronic kidney failure which requires dialysis or transplant. Chronic kidney failure afflicts about 700 Danes annually. 
 

Fewer complications revive transplant operations

This surgery is not the first of its kind in Denmark. From 1987-1994, 34 Danes underwent kidney and pancreas transplants at Rigshospitalet and Herlev Hospital. The transplants stopped, as the results were not satisfactory - neither in Denmark nor internationally. Since then, new methods and new medicines have reduced significantly the risk of complications following a transplant. On this basis, the Danish Health and Medicines Authority has allowed Rigshospitalet to recommence the transplants. 

- Rigshospitalet's Department of Surgical Gastroenterology, Department of Urology and Department of Nephrology are together generally responsible for these patients, but a number of other departments at Rigshospitalet are involved in the diagnostic evaluation and treatment of the patients, said Allan Rasmussen, Consultant, who is a trained transplant surgeon from Cambridge, and has previously performed pancreas transplants in Cambridge. 

In Denmark this cross-disciplinary competence only exists at Rigshospitalet, and with support from the university departments in the rest of Denmark, Rigshospitalet is once again performing this treatment option. Rigshospitalet is part of the Nordic collaboration in this area, and before the relaunch of the Danish transplant programme, the staff were trained in Oxford, England, and participated in pancreas transplants in Gothenburg, Sweden.  

Lack of donors limits the number of transplants

In future, Rigshospitalet expects to perform 13-15 pancreas transplants annually in Denmark. Only Rigshospitalet performs these highly specialised transplants, and patients will come from all over Denmark. In recent years, some patients have undergone a transplant in Oslo as part of the Nordic collaboration. 

Since the pancreas can only be taken from dead donors, the number of donors will decide how often Rigshospitalet can perform this transplant. The nephrology departments at Aarhus University Hospital, Odense University Hospital and Rigshospitalet refer the patients for the transplant. If a patient has been approved for transplant, he/she will be on a waiting list until a donor with a matching tissue type is ready. 

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